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Relations Representative Provider

Location:
New Braunfels, TX
Posted:
June 21, 2023

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Resume:

CHERA SOPER

**** ********** *** *** *********, Texas 78132 cell 806-***-****

adxt90@r.postjobfree.com www.linkedin.com/pub/chera-soper/1b/9a9/b21

Master’s-educated Healthcare Executive with proven success in delivering results and exceeding organizational goals. Sound business acumen with experience in developing and executing a wide range of sales, marketing, and business-development strategies to increase revenues and profitability. Key qualifications include:

Twenty plus years of experience in creating, implementing, managing, and growing networks within the healthcare insurance industry.

Proven negotiator who has secured more than 10,000 provider network contracts.

Trusted advisor to internal and external senior leaders, developing innovative strategies, processes, and procedures from the ground up.

Motivational leader of directly managed as well as cross-functional teams, coaching and positively influencing others to meet high performance standards.

Strong analytical skills with the ability to move easily from vision and strategy to implementation and follow-through.

Highly effective public speaking and presentation ability; keen interpersonal and written skills.

KEY COMPETENCIES

Competitive Analysis

Market Intelligence

Marketing Strategy

Contract Negotiations

Public Relations

Special Events Management

Positioning Strategies

Public Speaking

Product Development

PROFESSIONAL EXPERIENCE

THE PROMPTCARE COMPANIES dba ARJ INFUSION SERVICES, LLC – National, USA 2021 – 2023

National Account Manager, Managed Care Markets

Facilitated in developing, managing, and growing elite government and commercial provider networks for all 50 States nationally. Ensured specialty care needs of members were met. Educated provider and member communities on their contractual obligations. Supported in operations and complex projects utilizing cross-functional teams to meet strategic objectives for the Provider Network Management.

Streamlined company’s contracting process and negotiation of statewide contracts for all 50 States.

Oversee National Contracting and Network Growth.

Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and business unit objectives.

Analyze contract reimbursement to meet the needs of company expansion and revenue.

Adhering to all attendant policies and procedures.

SUPERIOR HEALTHPLAN – Austin, TX 2018 – 2020

Director, Operations

Operated Account Management Department for Travis and Central Medicaid Rural Service Area (MRSA) counties in Texas, for the largest managed health care plan for Texas government programs and the only plan to cover the Foster Care population and networks. Manage 15 employees in developing, implementing, and growing provider networks across 40 counties. Continuously monitor organizational data and workflows to advise management on business opportunities.

Achieve market share growth goals each year.

Increase HEDIS quality measures to surpass 70% across managed network.

Manage budget of for marketing programs to increase provider participation, member awareness and education.

Ensure 100% organizational compliance with all related laws, regulations, and executive orders.

Analyze financial and market share data to track and advise departments on goal attainment.

Create department’s strategic vision, objectives, and attendant policies and procedures.

SUPERIOR HEALTHPLAN – San Antonio, TX 2015 – 2018

Senior Director, Contracting and Network Development

Directed operations and complex projects utilizing cross-functional teams to meet strategic objectives for the Provider Lifecycle Management. Direct the development and implementation of contracting activities in network development and enhancement. Manage a production team of 22 employees to process all statewide provider agreements through a multi-department process to ensure participation in the network of more than 54,000 providers in all 254 counties in Texas.

Create a streamlined company’s statewide contracting process system, will increase department efficiency eliminating duplication and automating methods.

Developed the department’s first Quality Audit Team decreasing production error rates from 27% to 3%.

Oversee Contract Managements appeals and grievances to ensure 100% organizational compliance with all related laws, regulations, and executive orders.

Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and business unit objectives.

Manage and developed the Provider Termination and Retention Team.

Analyze contract production data to track and prioritize work processes.

Create department’s strategic vision, objectives, and attendant policies and procedures.

SUPERIOR HEALTHPLAN – Lubbock, TX 2011 – 2015

Director, Operations

Managed three departments, including Provider Networks, Community Ambassadors, and Clinical Nurse Liaisons, for the largest managed health care plan for Texas government programs. Manage 14 employees in developing, implementing, and growing provider networks across 73 Texas counties with up to 5000 participating providers and up to 75,000 eligible members. Continuously monitor organizational data and work flows to advise management on business opportunities. Negotiate provider contracts to achieve higher reimbursements, build new networks, and expand current networks with new providers and specialties.

Achieve market share growth goals each year.

Increase HEDIS quality measures to surpass 70% across managed network.

Negotiate over 100 new network contracts in collaboration with the market development team.

Manage budget of up to $100,000 for marketing programs to increase member awareness and education.

Ensure 100% organizational compliance with all related laws, regulations, and executive orders

Analyze financial and market share data to track and advise departments on goal attainment.

Create department’s strategic vision, objectives, and attendant policies and procedures.

Promote organization-wide success as Team Lead for internal employee committee (ASPIRE) that established company core values and regularly recognizes individuals for representing the values in their work.

FIRSTCARE HEALTH PLANS – Lubbock, TX 2002 – 2011

Provider Relations Manager (2007-2011)

Led the Lubbock Texas Regional Provider Relations Department in developing, managing, and growing elite government and commercial provider networks for 120 counties. Ensured specialty care needs of members were met. Educated provider and member communities on their contractual obligations.

Negotiated and secured approximately 1,500 provider networks.

Developed the organization’s first behavioral health network, securing direct contracts after bringing the specialty in-house from IPA relationships, and growing to over 200 networks.

Negotiated more than 1,000 new rates for member specialty care needs.

Hired, trained, and managed up to 25 employees, providing motivational leadership in attainment of business goals.

Ensured 100% organizational compliance of TDI and TMHP regulations.

Built database to streamline provider communications, increasing department efficiency by 15%.

CHERA SOPER

Senior Provider Relations Representative (2002-2007)

Led a team of four focused on securing, maintaining, and growing provider networks for the Lubbock Texas Region. Supported contract and reimbursement negotiations. Assisted providers with problem resolution and communicated with providers on policy changes.

Designed and presented at approximately 250 provider training programs and orientations.

Produced and lead five Annual Workshops for up to 700 providers, including development of agendas and materials as well as presentation of information to a diverse audience.

Identified gaps in care and negotiated 700 specialty contracts to meet network requirements.

Ensured 100% organizational compliance with state and federal regulations.

TEXAS TECH UNIVERSITY – Registrar’s Office Administrator, Lubbock, TX 1997-2001

AMERICAN MOVERS, INC. – Accounting, Waipio Gentry, HI 1993-1997

EDUCATION

Master of Business Administration Wayland Baptist University, Lubbock, TX 2010

Bachelor of Business Administration Wayland Baptist University, Lubbock, TX 2007

HONORS AND AWARDS

Twenty Under Forty Honor Award Lubbock Chamber of Commerce, 2013

President’s List and Dean’s List Wayland Baptist University, 2005-2007

Employee of the Month FirstCare Health Plans, November 2003

MEMBERSHIPS AND ASSOCIATIONS

United Way of Lubbock

Lubbock Chamber of Commerce

Young Professionals of Greater Lubbock (YPGL)

Junior League of Lubbock

The Junior Women’s Club

Society for Human Resource Management



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